Utilization Management Nurse Consultant - Behavioral Health (Remote)
Core
Review inpatient and outpatient behavioral health services using clinical judgment and evidence-based criteria to authorize care and escalate cases.
Role type
Utilization Management Nurse Consultant
Builds
Care management solutions for Aetna/CVS Health members
Domain
Healthcare / Behavioral Health / Utilization Management
Required skills
Clinical judgment, Evidence-based criteria application, Precertification authorization, Medical Director referral initiation, Multi-system navigation, Documentation accuracy
Preferred skills
Managed Care (MCO) experience, High-volume clinical call center experience, Remote work experience
Technologies
Computer-based systems, Telephone
Responsibilities
Review inpatient and outpatient services requiring precertification, Authorize procedures/services or initiate Medical Director referrals, Collaborate with providers, Navigate multiple systems, Maintain accurate documentation, Work occasional on-call rotational coverage on weekends and holidays
Seniority
Mid-level, hands-on IC